Deconstructing the Alcohol Harm Paradox: a population based survey of adults in England

Beard, E., Brown, J., West, R., Angus, C., Brennan, A., Holmes, J., Kaner, E., Meier, P. and Michie, S. (2016) Deconstructing the Alcohol Harm Paradox: a population based survey of adults in England. PLoS ONE, 11(9), e0160666. (doi: 10.1371/journal.pone.0160666) (PMID:27682619) (PMCID:PMC5040414)

Abstract

Background: The Alcohol Harm Paradox refers to observations that lower socioeconomic status (SES) groups consume less alcohol but experience more alcohol-related problems. However, SES is a complex concept and its observed relationship to social problems often depends on how it is measured and the demographic groups studied. Thus this study assessed socioeconomic patterning of alcohol consumption and related harm using multiple measures of SES and examined moderation of this patterning by gender and age. Method: Data were used from the Alcohol Toolkit Study between March and September 2015 on 31,878 adults (16+) living in England. Participants completed the AUDIT which includes alcohol consumption, harm and dependence modules. SES was measured via qualifications, employment, home and car ownership, income and social-grade, plus a composite of these measures. The composite score was coded such that higher scores reflected greater social-disadvantage. Results: We observed the Alcohol Harm Paradox for the composite SES measure, with a linear negative relationship between SES and AUDIT-Consumption scores (β = -0.036, p<0.001) and a positive relationship between lower SES and AUDIT-Harm (β = 0.022, p<0.001) and AUDIT-Dependence (β = 0.024, p<0.001) scores. Individual measures of SES displayed different, and non-linear, relationships with AUDIT modules. For example, social-grade and income had a u-shaped relationship with AUDIT-Consumption scores while education had an inverse u-shaped relationship. Almost all measures displayed an exponential relationship with AUDIT-Dependence and AUDIT-Harm scores. We identified moderating effects from age and gender, with AUDIT-Dependence scores increasing more steeply with lower SES in men and both AUDIT-Harm and AUDIT-Dependence scores increasing more steeply with lower SES in younger age groups. Conclusion: Different SES measures appear to influence whether the Alcohol Harm Paradox is observed as a linear trend across SES groups or a phenomenon associated particularly with the most disadvantaged. The paradox also appears more concentrated in men and younger age groups.

• Item Type: Articles
• Additional Information: The National Institute for Health Research (NIHR) School for Public Health Research (SPHR) primarily funded data collection for the Alcohol Toolkit Study (SPHR-SWP-ALC-WP5). SPHR is a partnership between the Universities of Sheffield; Bristol; Cambridge; Exeter; UCL; The London School for Hygiene and Tropical Medicine; the LiLaC collaboration between the Universities of Liverpool and Lancaster and Fuse; The Centre for Translational Research in Public Health, a collaboration between Newcastle, Durham, Northumbria, Sunderland and Teesside Universities. EB’s and SM’s salaries are funded by the NIHR SPHR. EB is also funded by Cancer Research UK (CRUK; C1417/A14135). JB is funded by the Society for the Study of Addiction and CRUK also provide support (C1417/A14135); RW is funded by CRUK (C1417/A14135).
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Meier, Professor Petra
• Authors: Beard, E., Brown, J., West, R., Angus, C., Brennan, A., Holmes, J., Kaner, E., Meier, P., and Michie, S.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > MRC/CSO SPHSU
• Journal Name: PLoS ONE
• Publisher: Public Library of Science
• ISSN: 1932-6203
• ISSN (Online): 1932-6203
• Copyright Holders: Copyright © 2016 Beard et al.
• First Published: First published in PLoS ONE 11(9): e0160666
• Publisher Policy: Reproduced under a Creative Commons License

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